How often a women should get Pap smears depends on age and medical history, says Dr. Elissa Gretz-Friedman.

The co-director of the Women's Health Program at Mount Sinai Medical Center, Gretz-Friedman is a gynecologist who deals with situations ranging from menopause to abnormal Pap smears. She works with patients of every age.

Who's at risk

The field of women's health takes a preventative approach, with a focus on problems that are unique to women or that affect women differently than men.

"Working alongside doctors who specialize in primary care, we create a personal health-screening prescription for each woman given her age, health history and family history," says Gretz-Friedman. "We strive to create awareness of the importance of screening in preventing and treating disease."

One of the biggest health concerns for women is cervical cancer, which affects the lower portion of the womb, or uterus, that extends into the vagina.

"In the past 10 years, we've discovered that cervical cancer is caused by HPV, the human papillomavirus," says Gretz-Friedman. HPV causes abnormal cell growth that goes through two precancerous stages — first atypical cells and then preinvasive dysplasia, which can develop into cancer if left untreated.

"All women are at risk of cervical cancer," says Gretz-Friedman. "HPV is so common that 50% of college-aged women contract the disease. Usually your own immune system cures it." The incidence of HPV drops dramatically with age as women clear the virus: 25% of women in their 20s have HPV, but only 3% to 4% of women in their 30s.

In recent years, highly effective HPV tests have helped hundreds of thousands of women a year detect the disease in its very early stages before it can develop into cancer. "At this point, there are only about 11,000 new cases of cervical cancer per year," says Gretz-Friedman.

Signs and symptoms

The key to fighting cervical cancer is catching it as early as possible, before the atypical cells can develop into cancer. "The preinvasive disease has no signs and symptoms," says Gretz-Friedman. "That's why screening is so important." Of the 11,000 cases of cervical cancer diagnosed each year, more than 50% of the women had had no Pap smear in the previous five years.

Once the precancerous stages turn into cervical cancer, the most common symptom is irregular spotting or bleeding, especially after intercourse. "Bleeding can be the result of many things," says Gretz-Friedman. "The important thing is to discuss it with your doctor."

Traditional treatment

In 2009, the American College of Obstetrics and Gynecology recommended that women start getting Pap smears at the age of 21; if the test finds atypical cells, then the doctor will run an HPV test. When women turn 30, they are advised to have both a Pap smear and HPV screening together.

An abnormal Pap smear calls for further testing.

"The next step is colposcopy, a procedure done in the office. The cervix is examined with a microscope-type instrument. If anything looks abnormal, biopsies are taken. "It is common to need to have additional testing," says Gretz-Friedman. If doctors find mild changes, they follow the patient and watch for additional changes. "Usually your immune system gets rid of the HPV and the changes revert to normal," says Gretz-Friedman.

If the abnormal cells have already progressed to severe dysplasia, more active treatment is in order. "It's pretty rare that it reaches this point, but then surgery is called for," says Gretz-Friedman. "The primary option is called a LEEP procedure, in which we excise the abnormal area of the cervix." It can be done in the doctor's office or the OR, depending on the patient. "The other option is a Cone biopsy, which is the same procedure, but done using a scalpel or laser."

Research breakthroughs

Treatment of cervical cancer has been radically transformed over the past decade. "The discovery that HPV was the cause of cervical cancer was a huge breakthrough," says Gretz-Friedman. "Having the test available and then the vaccine for prevention have really helped us cut the incidence of cervical cancer dramatically — down 65% since 1975."

Questions for your doctor

A good first question for your doctor is, "How often should I be getting screened?" The answer depends on your age and health history. If your Pap smear shows an abnormality, ask "Are the changes low-grade or high-grade?" Following the screening guidelines for cervical, breast and colon cancer can go a long way to protecting your health. "The death rate for these cancers is way down, and our greatest strides have been made from early detection," says Gretz-Friedman.

What you can do

Get screened.

Women ages 21 to 30 should have yearly Pap smears. After you hit 30, your doctor may clear you to be screened once every three years.

Stick to your yearly gynecology appointments.

Even if you don't need the yearly Pap smear, doctors recommend a yearly visit so you can have a breast exam and get screened for other diseases.

Get vaccinated.

The HPV vaccine is recommended for women between ages 9 and 26. "It's close to 100% effective," says Gretz-Friedman. "And it is most effective to be vaccinated before ever having sexual contact."